摘要
背景:人工全膝关节置换术被认为是治疗终末期或严重的膝关节炎的最有效、最成功的手术之一。如何降低假体返修率、提高膝关节置换术后的疗效是亟待解决的主要问题。目的:回顾性分析不同类型人工膝关节假体的临床应用及其疗效。设计:以膝关节置换术后患者为观察对象,手术前后对照观察,以对比不同类型人工膝关节假体置换术后效果。单位:解放军总医院骨科。对象:选择解放军总医院2002-01/2005-01收治的398例患者(523个置换膝关节),其中单膝关节置换术276例,276膝,双膝同时置换122例,244膝。诊断分别为骨性关节炎、类风湿关节炎、强直性脊柱炎、色素绒毛结节性滑膜炎。方法:根据患者病情适当选择不同类型人工膝关节假体进行全膝关节置换术。假体的类型包括:①按置换范围,分单髁、全髁型;在全髁置换分为后交叉韧带保留型和后交叉韧带替代型假体。②按限制程度又分限制性、非限制性和半限制性。③按是否模拟半月板功能,又分为胫骨平台垫可旋转滑动型和固定型。半年后对以上患者进行随访,膝关节评分采用美国特种外科医院膝关节评分系统(HSS评分,满分为100分,85分以上为优;70～84分为良;60～69分为尚可;60分以下为差),髌骨评分采用Feller等评分标准(满分30分,得分越高越好),随访时调查膝前区疼痛轻重、膝关节活动范围及稳定程度比较,拍摄膝关节正、侧及髌骨30°,90°轴位X射线片。主要观察指标:患者手术前后HSS评分、髌骨评分、膝前痛评分、髌骨功能评分、膝关节最大屈曲度、股胫角。结果:完成随访372例(490膝),随访率93.4%。①疗效:手术优良率89%。患者术后在疼痛、功能方面都有明显改善,尤其在缓解疼痛及膝关节活动范围方面效果显著。②患者术后随访的HSS评分、髌骨评分、膝前痛评分、髌骨功能评分、最大屈膝度均较术前增加
BACKGROUND： The total knee replacement is considered as one of the most effective and successful operations to cure terminal or severe gonarthritis. How to lower the revision rate as well as increase the effect of prostheses after the knee replacement should be solved urgently.
OBJECTIVE： To retrospectively analyse the clinical applications and curative effects of different knee prostheses
DESIGN： Based on patients who accepted knee replacement, preoperative and postoperative condition was observed and compared so as to compare the postoperative effect of different types of knee prostheses replacements.
SETTING： Department of Orthopedics, General Hospital of Chinese PLA.
PARTICIPANTS： A total of 398 patients （523 knees） were selected from the Department of Orthopedics, General Hospital of Chinese PLA from January 2002 to January 2005, including 276 unilateral knee replacements （276 knees） and 122 bilateral knee replacements （244 knees）. Patients were respectively diagnosed as osteoarthritis （OA）, rheumatoid arthritis （RA）, ankylosing spondylitis （AS）, pigmented villonodular synovitis （PVNS）, etc.
METHODS ： According to the pathogenetic condition, patients received total knee replacements with different knee prostheses. Types of knee prostheses： ①According to the replacing range, it could be divided into unicondylar prostheses and total condylar prostheses; total condylar prostheses could be subdivided into posterior cruciate ligament （PCL）-retaining and PCL-substituting prostheses. ②According to the degree of mechanical constraint, it could be divided into uno constrained, semiconstrained or fully constrained prostheses.③ According to whether imitating meniscus-function, it could be divided into tibial plateau rotatable sliding type and fixed type. Follow-up was conducted on patients that mentioned above after half a year. Knee joints were scored by using knee joint scoring system of American special surgical hospital （HSS scoring with the total scor
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第8期1563-1566,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
